title: Can DWI-ASPECTS substitute for lesion volume in acute stroke?
abstract: OBJECTIVE
  The extent of diffusion lesion on pretreatment imaging is a risk factor for poor outcome and hemorrhagic transformation after thrombolysis, and volumes of 70 to 100 mL have been advocated as cut-offs. However, estimating diffusion-weighted imaging (DWI) lesion volume (VolDWI) in the acute setting may be cumbersome. We aimed to determine whether the DWI-Alberta Stroke Program Early CT Score (DWI-ASPECTS) can substitute for VolDWI.
  
  
  METHODS
  DWI-ASPECTS and VolDWI were measured retrospectively on pretreatment MRI (median onset-to-MRI delay=122 minutes) in 330 consecutively treated patients with middle cerebral artery stroke.
  
  
  RESULTS
  DWI-ASPECTS and VolDWI were strongly correlated (ρ=-0.82), but each DWI-ASPECTS point corresponded to a wide range of VolDWI. All patients with DWI-ASPECTS≥7 (n=207) had VolDWI<70 mL, whereas 32 of the 34 patients with DWI-ASPECTS<4 had VolDWI>100 mL. However, intermediate DWI-ASPECTS (4-6; n=89) corresponded to highly variable VolDWI (median, 66 mL; interquartile range, 40-98).
  
  
  CONCLUSIONS
  Although each DWI-ASPECTS point corresponds to a wide range of volumes, DWI-ASPECTS<4 or ≥7 may be used as reliable surrogates of VolDWI>100 or <70 mL, respectively.
authors.affiliation: From the Departments of Radiology (C.d.M.-M., M.T., O.N., L.L., J.-F.M., C.O.) and Neurology (G.T., D.C., J.-L.M., J.-C.B.), Centre de Psychiatrie et Neurosciences, INSERM S894, Centre Hospitalier Sainte-Anne, Université Paris Descartes Sorbonne Paris Cité, Paris, France.
authors.forename: Constance
authors.initials: C
authors.lastname: de Margerie-Mellon
authors.forename: Guillaume
authors.initials: G
authors.lastname: Turc
authors.forename: Marie
authors.initials: M
authors.lastname: Tisserand
authors.forename: Olivier
authors.initials: O
authors.lastname: Naggara
authors.forename: David
authors.initials: D
authors.lastname: Calvet
authors.forename: Laurence
authors.initials: L
authors.lastname: Legrand
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Meder
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Mas
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Baron
authors.forename: Catherine
authors.initials: C
authors.lastname: Oppenheim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D002545:Brain Ischemia / Q000473:pathology* / Q000503:physiopathology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000473:pathology* / Q000503:physiopathology
keywords: ASPECTS; diffusion-weighted imaging; stroke; thrombolytic therapy